2570 What's the Limit of Total Laparoscopic Myomectomy?∼In Terms of Intraoperative Conversion∼

Abstract

Video Objective To assess what limit to complete surgical procedure of laparoscopic myomectomy (LM), I review surgical outcomes of cases performed LM, laparoscopy-assisted myomectomy (LAM) and abdominal myomectomy (AM), and present the cases converted from LM to LAM. Design Retrospective cohort study. Setting Urban general hospital in Japan. Patients All women who were underwent myomectomy, between 2014 to 2018. Interventions Medical records were reviewed for baseline characteristics and perioperative outcomes. Measurements and Main Results First, I present our operative procedure of LM. We have modified diamond trocar placement.After the vasopressin injection into the myometrium of fibroid surface,we make incisions with ultrasonic or electric scalpel and enucleate fibroids. After the suturing of myometrium, we make posterior colpotomy and carry out them transvaginally. If fibroids are too large to be carried out, we perform intracorporal or intravaginal manual morcellation. Second, A total of 1123 patients were undergone myomectomy in our hospital between 2014 to 2018. The mean ±SD specimen weight of LM, LAM, AM was 180.5±153, 597.0±389.1, 972.9±738.9g, dominant myoma diameter was 6.7±2.4, 10.3±3.6, 12.8±5.8cm. 4 out of 1029 (0.39༅) LM cases were shifted to LAM during surgery, one case due to numerous myoma and three cases due to severe intraabdominal adhesion. No difference in perioperative complications was found for LM group with other procedures. All cases were performed blood test and imaging test by ultrasonography or magnetic resonance imaging (MRI) preoperatively. When a malignancy is suspected, the specimen is extracted using a protection bag. In 1123 cases performed uterus-preserving surgery, only 1 case (0.09%) was revealed as malignant postoperatively. Conclusion LM is feasible and safe surgical procedure with appropriate selection of patients.